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If you’re eligible for Medicare, you qualify for the Medicare Part D Prescription Drug Benefit. It’s that simple. For most people this means that if you’re 65 or older – or are on Medicare and Medicaid because of qualifying disabilities – you’re eligible for this benefit. Whether or not you choose to take advantage of this benefit is up to you.
To get this benefit, you will choose and apply for a program or “plan” in your area. You don’t have to get this benefit – enrollment is your choice. You will receive information on the prescription drug plans in your area that are approved by the Centers for Medicare & Medicaid Services.
You will have several different drug plans to choose from. You may also already have some prescription drug coverage through a Medigap insurance policy, or through an employee or retiree benefit. You should figure out what you currently spend on your medicines, and how these different options will affect you.
This new prescription drug benefit is similar to insurance–you pay a premium for the plan you choose, and get specific benefits and coverage for your medications. If you don’t take many medications right now, the cost of the premiums plus co-insurance or co-pay (the part you pay out of pocket) may be about what you’re paying now. However, there are still several reasons to consider signing up now.
If you are eligible to enroll, there is an advantage to signing up now, even if you don’t think you need this amount of coverage. If you wait to pay, your premium (the monthly cost for the plan) will go UP because of a “penalty” clause. You should sign up during the open enrollment period, from November 15th - December 31st, to avoid this penalty. Think about your future drug needs as well as what you take right now.
If you’re receiving (or are eligible for) Medicaid assistance from your state as well as Medicare, this new program may help pay your premiums and co-pays. (You might also qualify, if you have low income and assets–contact your state Medicaid office for information.) You have to apply for this additional assistance through your state Medicaid agency. If you qualify for this assistance, you will automatically be assigned to a Prescription Drug Plan in your area.
Just like insurance, if you’re paying your premiums and develop a new condition or illness that requires expensive medication, you're covered. Once you satisfy the co-pay and maximum out-of-pocket costs, this plan will pay for almost all of your prescription drug expenses. With the cost of medications to treat certain diseases (like diabetes, heart conditions or cancer), this could be a sizeable amount. What is your peace of mind worth?
The purpose of the Medicare Part D Prescription Drug Plan is to make your prescriptions more affordable. With the purchasing power of the plans throughout the country, even when you’re paying the full cost for your prescription (like when you are meeting your deductible portion) you’ll still be getting a discounted price. And if your drug needs increase, you’re covered.
With your prescription drug plan, you will be able to choose from a number of approved pharmacies in your area. The drugs that qualify have been government-approved, and are on a list called a “formulary.” Some plans will provide a mail order prescription option, so you can have medications delivered to your home. All of these choices are designed to help you save money on the medicines you need.
Each year the open enrollment period is November 15th through December 31st; during which you can choose to change plans. Or, you can stay with the plan where you are enrolled. If you change plans during this annual enrollment period, you won’t pay the penalty that those who failed to sign up during the open enrollment period.